MEDICARE: MICHAEL M. DILLINGHAM, D.D.S.,P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	15903	TX

General Provider Information

NPI Number	:	1598856684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL M. DILLINGHAM, D.D.S.,P.C.

Provider Business Mailing Address
First Line	:	2121 W PARMER LN
Second Line	:	STE. 111
City	:	AUSTIN
State	:	TX
Zip	:	78727-4300
Country	:	US
Telephone Number	:	512-836-7924
Fax Number	:	512-836-7977

Provider Business Practice Location Address
First Line	:	2121 W PARMER LN
Second Line	:	STE. 111
City	:	AUSTIN
State	:	TX
Zip	:	78727-4300
Country	:	US
Telephone Number	:	512-836-7924
Fax Number	:	512-836-7977

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	STEFFINEY ORTON
Credential	:
Telephone Number	:	512-836-7924

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	08/22/2020

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